Carboxyhemoglobin, Methemoglobin and Lactate Levels in Patients with Systemic Inflammatory Response Syndrome

Year 2021, , 80 - 87, 05.05.2021

Selahattin Gürü , Gültekin Kadı , Begüm Öktem Mehmet Karamercan

https://doi.org/10.47482/acmr.2021.19

Abstract

Background: Systemic inflammatory response syndrome (SIRS) is a common, severe inflammatory condition. This condition forms the basis of the definitions of sepsis, severe sepsis, septic shock, and multiple organ failure syndromes. The diagnosis can be made earlier with arterial blood gas analysis, which can provide a lot of information within minutes. This study aimed to determine the value of carboxyhemoglobin (COHb), methemoglobin (metHb), and lactate levels in the prognosis and mortality of patients with SIRS.

Methods: Patients who met the SIRS criteria with the first vital signs and laboratory values and who had arterial blood gas analysis according to the clinician’s decision were included in the study. The demographic characteristics, prognosis and correlation of 1-month mortality rates of patients with baseline COHb, metHb and lactate levels were investigated.

Results: Among non-smoker patients, no significant difference was found between fCOHb values and age, gender, presence of infection, blood pressure, department of hospitalization, and 1-month mortality rates (p>0.05). Also, the relationship between fCOHb values and length of stay in the hospital was not statistically significant (r = -0.013, p = 0.883). Among the patients included in the study; there was no significant difference in metHb values between age groups (p = 0.9941), gender (p = 0.6422), presence of infection (p = 0.1311), blood pressure (p = 0.7711), length of stay in hospital (p = 0.737), inpatient clinics (p = 0.6722) and 1-month mortality (p = 0.8752). Lactate values were found to be correlated with the 1-month mortality of the patients (p = 0.005). Lactate levels were significantly higher in patients who died within 1-month compared to those who survived.

Conclusions: In patients with SIRS, initial COHb and metHb values cannot be considered a predictor for prognosis and mortality. However, lactate values may be useful to predict SIRS mortality even during hospital admission.

Keywords

SIRS, Carboxyhemoglobin, Methemoglobin, Lactate.

References

• 1. Horeczko T, Green JP, Panacek EA. Epidemiology of the Systemic Inflammatory Response Syndrome (SIRS) in the emergency department. West J Emerg Med. 2014;15(3):329-36.
• 2. Comstedt P, Storgaard M, Lassen AT. The Systemic Inflammatory Response Syndrome (SIRS) in acutely hospitalised medical patients: a cohort study. Scand J Trauma Resusc Emerg Med. 2009;17:67.
• 3. Bloom BM, Grundlingh J, Bestwick JP, Harris T. The role of venous blood gas in the emergency department: a systematic review and meta-analysis. Eur J Emerg Med. 2014;21(2):818.
• 4. Slebos DJ, Ryter SW, Choi AM. Heme oxygenase-1 and carbon monoxide in pulmonary medicine. Respir Res. 2003;4(1):7.
• 5. Wennmalm A, Benthin G, Petersson AS. Dependence of the metabolism of nitric oxide (NO) in healthy human whole blood on the oxygenation of its red cell haemoglobin. Br J Pharmacol. 1992;106(3):507-8.
• 6. Kosaka H, Uozumi M, Tyuma I. The interaction between nitrogen oxides and hemoglobin and endothelium-derived relaxing factor. Free Radic Biol Med. 1989;7(6):653-8.
• 7. Schuerholz T, Irmer J, Simon TP, Reinhart K, Marx G. Methemoglobin level as an indicator for disease severity in sepsis. Crit Care. 2008;12(Suppl 2):P448-P.
• 8. Singer AJ, Taylor M, Domingo A, Ghazipura S, Khorasonchi A, Thode HC, Jr., et al. Diagnostic characteristics of a clinical screening tool in combination with measuring bedside lactate level in emergency department patients with suspected sepsis. Acad Emerg Med. 2014;21(8):853-7.
• 9. James JH, Luchette FA, McCarter FD, Fischer JE. Lactate is an unreliable indicator of tissue hypoxia in injury or sepsis. Lancet. 1999;354(9177):505-8.
• 10. de Siqueira ME, Martins I, Costa AC, Andrade EL, Esteves MT, Lima SA. [Reference values for carboxyhemoglobin]. Rev Saude Publica. 1997;31(6):618-23.
• 11. Moncure M, Brathwaite CE, Samaha E, Marburger R, Ross SE. Carboxyhemoglobin elevation in trauma victims. J Trauma. 1999;46(3):424-7.
• 12. Hunter K, Mascia M, Eudaric P, Simpkins C. Evidence that carbon monoxide is a mediator of critical illness. Cell Mol Biol (Noisy-legrand). 1994;40(4):507-10.
• 13. Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: etiology, pharmacology, and clinical management. Ann Emerg Med. 1999;34(5):646-56.
• 14. Ohashi K, Yukioka H, Hayashi M, Asada A. Elevated methemoglobin in patients with sepsis. Acta Anaesthesiol Scand. 1998;42(6):713-6.
• 15. Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004;32(8):1637-42.
• 16. Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009;37(5):1670-7.